Provider Demographics
NPI:1528882511
Name:ADEJUWON, GBADEBO
Entity type:Individual
Prefix:
First Name:GBADEBO
Middle Name:
Last Name:ADEJUWON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 SAINT PAUL DR APT 253
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7363
Mailing Address - Country:US
Mailing Address - Phone:214-475-9450
Mailing Address - Fax:
Practice Address - Street 1:923 SAINT PAUL DR APT 253
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7363
Practice Address - Country:US
Practice Address - Phone:214-475-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver